The Clinical Quality Consultant leads quality improvement initiatives through data analysis, performance monitoring, and reporting. Partners with the entire clinical operations teams to support process improvement, regulatory compliance, project management, and performance initiatives that enhance operational effectiveness.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:- Quality Improvement
- Develop, analyze, and monitor quality, operational, and behavioral health metrics to identify trends, risks, and opportunities for improvement
- Support NCQA accreditation activities, government program requirements, contractual obligations, and other regulatory requirements
- Design, implement, and evaluate quality improvement initiatives, including HEDIS®, to drive measurable performance outcomes
- Translate quality findings into measurable goals, improvement strategies, and actionable recommendations
- Prepare and present reports, dashboards, executive summaries, and performance updates for leadership, customers, and external stakeholders
- Ensure data integrity and content accuracy through quality assurance review of monthly, quarterly, and annual customer reporting submissions
- Act as a secondary resource for member and provider complaint review and resolution, ensuring timely and compliant handling
- Clinical Operations Support and Compliance
- Provide project management, consultation, process improvement, and operational support to Utilization Management (UM), Care Management (CM), Care Coordination, Quality, and other Clinical Operations teams
- Partner with operational leaders to develop and implement solutions that support strategic priorities, operational effectiveness, compliance, quality performance, and member outcomes
- Conduct audits and reviews of clinical documentation, operational processes, and procedures to ensure compliance with organizational, contractual, accreditation, and regulatory requirements
- Assess operational performance, identify process gaps, and recommend workflow improvements that enhance efficiency, quality, and compliance
- Support cross-functional initiatives and regulatory readiness activities to ensure ongoing compliance and successful operational execution
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:- 4+ years of experience in behavioral health direct service (mental health or substance use) or behavioral healthcare operations
- 2+ years of experience leading or supporting quality improvement, performance improvement, or process improvement initiatives
- Experience collecting, analyzing, interpreting, and presenting data to support decision-making and performance improvement
- Proven solid analytical, organizational, and communication skills
- Proven ability to manage multiple priorities and work collaboratively across teams
Preferred Qualifications:- Experience developing reports, dashboards, and performance summaries
- Experience with healthcare quality measures and programs, including HEDIS® and NCQA standards
- Experience supporting regulatory, accreditation, or contractual compliance requirements
- Experience with behavioral health quality and operational performance metrics
- Project management experience, including leading cross-functional initiatives and tracking deliverables
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
